Trombose venosa profunda de membros superiores: estudo coorte retrospectivo de 52 casos
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Data
2005-09-01
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Editor
Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
Resumo
OBJETIVO: Rever os fatores predisponentes e a evolução em série de casos de trombose venosa profunda dos membros superiores de nossa instituição. MÉTODOS: Cinqüenta e dois pacientes consecutivos, com trombose venosa profunda dos membros superiores (29 homens e 23 mulheres), idade média de 52,3 anos, documentados por mapeamento dúplex (71,1%), flebografia (11,1%) ou clinicamente (15,6%), foram incluídos no presente estudo. RESULTADOS: As manifestações clínicas foram: dor no antebraço (24 casos - 46,1%), dor no braço (27 casos - 51,9%), edema do membro superior (45 casos - 86,5%), dor à compressão do membro superior (36 casos - 70,2%) e dor à movimentação do mesmo (32 casos - 61,7%). Os principais fatores de risco foram: punção ou acesso venoso (20 casos - 39,1%) e câncer (16 casos - 32,6%). As veias envolvidas foram: umeral (n = 18), axilar (n = 27), subclávia (n = 15) e jugular (n = 11). A embolia pulmonar estava inicialmente presente em quatro casos (7,6%). O tratamento inicial foi feito com heparina não-fracionada intravenosa (64,3%), subcutânea (16,7%), ou heparina de baixo peso molecular (17,1%), seguido de varfarina. Doze pacientes morreram antes da alta, em função de causas não relacionadas à embolia pulmonar. Foram acompanhados os 40 pacientes restantes por período de 3 meses a 10 anos, sendo que dois morreram de causas não relacionadas à embolia pulmonar, um paciente desenvolveu seqüelas pós-trombóticas, como edema residual e limitações aos movimentos, e seis ficaram com discretos sintomas residuais (edema e dor). CONCLUSÕES: A trombose venosa profunda dos membros superiores foi mais freqüente em pacientes submetidos a acessos venosos e com neoplasia em atividade. Comparando com dados da literatura, a evolução dos pacientes sob tratamento exclusivo com anticoagulantes foi, no mínimo, similar a outros tratamentos propostos.
OBJECTIVE: To review the predisposing factors and the evolution of upper-extremity deep vein thrombosis in a series of cases. METHODS: Fifty-two consecutive patients (29 men and 23 women, mean age of 52.3 years) with upper-extremity deep vein thrombosis documented by duplex scan (71.1%), phlebography (11.1%) or clinically (15.6%) were included in the study. RESULTS: Clinical manifestations were: forearm pain (24 cases - 46.1%), arm pain (27 cases - 51.9%), upper limb edema (45 cases - 86.5%), pain to arm compression (36 cases - 70.2%) and to arm movement (32 cases - 61.7%). Main risk factors were: vein puncture (20 cases - 39.1%), and cancer (16 cases - 32.6%). Deep vein thrombosis involved humeral (n = 18), axillary (n = 27), subclavian (n = 15) and jugular (n = 11) veins. Pulmonary embolism was initially present in four cases (7.6%). Initial therapy included unfractionated heparin, intravenous (64.3%), subcutaneous (16.7%) or low molecular weight heparin (17.1%) administration, followed by warfarin. Twelve patients died before discharge from the hospital, due to causes not related to pulmonary embolism. The remaining 40 patients were followed-up for a period of 3 months to 10 years. Two died of causes not related to pulmonary embolism, one developed post-thrombotic sequels, such as residual edema and limitations to upper limb movement, and six had discrete residual symptoms (edema and pain). CONCLUSIONS: Upper-extremity deep vein thrombosis was more frequent in patients submitted to venous access and with active neoplasia. The outcome of patients exclusively treated with oral anticoagulant was at least similar to other treatments proposed in the literature.
OBJECTIVE: To review the predisposing factors and the evolution of upper-extremity deep vein thrombosis in a series of cases. METHODS: Fifty-two consecutive patients (29 men and 23 women, mean age of 52.3 years) with upper-extremity deep vein thrombosis documented by duplex scan (71.1%), phlebography (11.1%) or clinically (15.6%) were included in the study. RESULTS: Clinical manifestations were: forearm pain (24 cases - 46.1%), arm pain (27 cases - 51.9%), upper limb edema (45 cases - 86.5%), pain to arm compression (36 cases - 70.2%) and to arm movement (32 cases - 61.7%). Main risk factors were: vein puncture (20 cases - 39.1%), and cancer (16 cases - 32.6%). Deep vein thrombosis involved humeral (n = 18), axillary (n = 27), subclavian (n = 15) and jugular (n = 11) veins. Pulmonary embolism was initially present in four cases (7.6%). Initial therapy included unfractionated heparin, intravenous (64.3%), subcutaneous (16.7%) or low molecular weight heparin (17.1%) administration, followed by warfarin. Twelve patients died before discharge from the hospital, due to causes not related to pulmonary embolism. The remaining 40 patients were followed-up for a period of 3 months to 10 years. Two died of causes not related to pulmonary embolism, one developed post-thrombotic sequels, such as residual edema and limitations to upper limb movement, and six had discrete residual symptoms (edema and pain). CONCLUSIONS: Upper-extremity deep vein thrombosis was more frequent in patients submitted to venous access and with active neoplasia. The outcome of patients exclusively treated with oral anticoagulant was at least similar to other treatments proposed in the literature.
Descrição
Palavras-chave
trombose, trombose venosa, extremidade superior, anticoagulantes, thrombosis, deep vein thrombosis, upper extremities, anticoagulants
Como citar
Jornal Vascular Brasileiro. Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV), v. 4, n. 3, p. 275-282, 2005.